To use the Obamacare or Not in 2021?

If your 2021 income is above the household income threshold, you are usually better off shopping outside of the exchange.
I received a call from an executive assistant yesterday. She represents a successful solopreneur, and her client is in search of a better health insurance plan.
Most important to him is the access to physicians, or network access.

This is the second inquiry like this in the last month because people are frustrated with on-exchange ( EPO and HMO networks.  Each time, there was not a cost consideration regarding health insurance premiums. They just needed a better plan with better access, regardless of cost.

You cannot buy access to a PPO on the exchange.

In consideration of all the built-in benefits of the ACA (so-called ObamaCare), access is becoming increasingly restricted, especially when you need a specialist. The specialist that handled your neighbor’s GI issues or reconstructed your brother’s ACL is probably less than 50% likely to be in network with your subscribed ACA Bronze/Silver or Gold plan.

PPO networks stopped being offered on the exchange/marketplace in 2015 so that the insurance companies could try to reduce costs, creating a number of narrower networks withlower physician reimbursement rates to keep premiums down.

In addition, out-of-pocket maximums (OOP) have been increased from $6,300 in 2014 to $8,550 in 2021 for the same reason — your heart attack or stroke or shoulder reconstruction leaves you with 35% more out-of-pocket responsibility in most cases.  For those who qualify for the federal subsidies (tax credits) that are available, is excellent and a life saver with its guaranteed issue plans (no pre-existing condition exclusion).

However, if your expected 2021 income is above the household income threshold, you may be able to secure a better overall policy shopping outside of the exchange.

PPO networks are available off the exchange, and frequently at lower premium prices for those who can qualify. This means access to all physicians in Colorado, for example, and about 95% of physicians, specialists and hospitals across the U.S. including Mayo Clinic, Cleveland Clinic and most of the pre-eminent specialty hospitals across the country.

Happy to discuss this further…